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2.
Pediatr Infect Dis J ; 40(8): e310-e311, 2021 08 01.
Artigo em Inglês | MEDLINE | ID: covidwho-1541587

RESUMO

The dynamics of intrafamilial spread of SARS-CoV-2 during January-February 2021 when variant B.1.1.7 predominated were compared with data from April to May 2020, when other circulating variants prevailed. Much higher intrafamilial transmission rates among all age groups, in particular in young children, and lower rates of sensory impairment were demonstrated during January-February 2021.


Assuntos
COVID-19/epidemiologia , COVID-19/virologia , SARS-CoV-2/classificação , Adolescente , COVID-19/transmissão , Criança , Pré-Escolar , Feminino , Humanos , Hipestesia/epidemiologia , Hipestesia/virologia , Lactente , Recém-Nascido , Israel/epidemiologia , Masculino , SARS-CoV-2/genética , Adulto Jovem
3.
Isr J Health Policy Res ; 10(1): 40, 2021 07 15.
Artigo em Inglês | MEDLINE | ID: covidwho-1533279

RESUMO

BACKGROUND AND PURPOSE: Marked reductions in imaging exams have been documented during the COVID-19 pandemic. The study aimed to examine the effect of the two waves of COVID-19 on magnetic resonance imaging (MRI) utilization at the national and regional level. MATERIALS AND METHODS: A retrospective-archive study was conducted in Israel, comparing March-December 2020 with March-December 2018 and 2019. Data on MRI utilization were obtained from the national MRI registry, while data on confirmed COVID-19 cases, by place of residence, were obtained from the Israeli Ministry of Health open COVID-19 database. RESULTS: The number and rate of MRI examinations decreased during the first COVID-19 wave, with the steepest drop in April 2020: 47.5% relative decrease compared to April 2019, and 42.2% compared to 2018. This was followed by a compensatory increase between the waves and a return to almost pre-pandemic levels of use, with just a modest decrease, during the second, more intense COVID wave, compared with the previous year. Existing differences between regions increased during the pandemic. The rate ratio of MRI exams between Tel-Aviv and the Northern periphery increased from 2.89 in April 2019 to 3.94 in April 2020. Jerusalem metropolitan region, with the largest burden of COVID disease, demonstrated only a modest decrease (1%) in MRI utilization during the first 10 months of the pandemic. CONCLUSIONS: At the national level, time trends in reduced MRI utilization followed the first wave of COVID-19, and were accompanied by increased regional disparities. These changes were not explained by differences in the burden of COVID-19 disease but might be explained by unequal distribution of MRI scanners among regions. Reduced utilization was not evident during the second wave, nor at the beginning of the third wave, despite higher COVID-19 case load, demonstrating adaptation to the new normal. Patterns of MRI utilization might help policy-makers and healthcare managers predict the behavior of imaging as well as other sectors, such as elective surgical procedures, during an ongoing pandemic. This forecast might help to manage the lasting effects of the pandemic, including extended waiting times, in the months and years following its remission. In preparation for future national emergencies, timely and detailed data on MRI utilization can serve as a "sensor" for a wide array of diagnostic and interventional medical activities, providing policy-makers with an updated snapshot to guide their response at the regional and national levels.


Assuntos
COVID-19/epidemiologia , Imageamento por Ressonância Magnética/estatística & dados numéricos , Pandemias , Utilização de Procedimentos e Técnicas/tendências , Humanos , Israel/epidemiologia , Estudos Retrospectivos
4.
Euro Surveill ; 26(45)2021 Nov.
Artigo em Inglês | MEDLINE | ID: covidwho-1515521

RESUMO

The SARS-CoV-2 Lambda (Pango lineage designation C.37) variant of interest, initially identified in Peru, has spread to additional countries. First detected in Israel in April 2021 following importations from Argentina and several European countries, the Lambda variant infected 18 individuals belonging to two main transmission chains without further spread. Micro-neutralisation assays following Comirnaty (BNT162b2 mRNA, BioNTech-Pfizer) vaccination demonstrated a significant 1.6-fold reduction in neutralising titres compared with the wild type virus, suggesting increased susceptibility of vaccinated individuals to infection.


Assuntos
COVID-19 , SARS-CoV-2 , Vacinas contra COVID-19 , Humanos , Israel/epidemiologia , Vacinação
5.
Sci Rep ; 11(1): 22120, 2021 11 11.
Artigo em Inglês | MEDLINE | ID: covidwho-1510614

RESUMO

The outbreak of the Coronavirus disease 2019 (COVID-19), and the drastic measures taken to mitigate its spread through imposed social distancing, have brought forward the need to better understand the underlying factors controlling spatial distribution of human activities promoting disease transmission. Focusing on results from 17,250 epidemiological investigations performed during early stages of the pandemic outbreak in Israel, we show that the distribution of carriers of the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), which causes COVID-19, is spatially correlated with two satellite-derived surface metrics: night light intensity and landscape patchiness, the latter being a measure to the urban landscape's scale-dependent spatial heterogeneity. We find that exposure to SARS-CoV-2 carriers was significantly more likely to occur in "patchy" parts of the city, where the urban landscape is characterized by high levels of spatial heterogeneity at relatively small, tens of meters scales. We suggest that this spatial association reflects a scale-dependent constraint imposed by the city's morphology on the cumulative behavior of the people inhabiting it. The presented results shed light on the complex interrelationships between humans and the urban landscape in which they live and interact, and open new avenues for implementation of multi-satellite data in large scale modeling of phenomena centered in urban environments.


Assuntos
COVID-19/epidemiologia , Cidades/epidemiologia , Atividades Humanas , Humanos , Israel/epidemiologia , SARS-CoV-2/isolamento & purificação , Imagens de Satélites , População Urbana
6.
Isr J Health Policy Res ; 10(1): 62, 2021 11 01.
Artigo em Inglês | MEDLINE | ID: covidwho-1496220

RESUMO

BACKGROUND: The Covid-19 pandemic began in Israel on February 2020. Between February and October 2020, 2 periods of lockdown were imposed on Israeli population. OBJECTIVE: To assess the effect of the Covid-19 pandemic on visits to the emergency department (ED) and on hospitalizations in medical wards in Israel's Chaim Sheba Medical Center, and to compare the effect during the first and second lockdowns. METHODS: Data regarding the number of visits of non-Covid-19 patients to the ED and the number of admissions to the medical wards, were extracted from the computerized system of the hospital. Data were analyzed for patients' characteristics, length of stay in the medical wards, in hospital mortality and the rate of 7 and 30 days re-hospitalization, and compared to the same period during 2019. RESULTS: Total visits to the Sheba ED during March-October decreased by 18.5%. The most dramatic decrease occurred during the first lockdown. The number of patients admitted to the Sheba medical wards decreased by 28% (P < 0.05). The length of stay decreased from 3.69 days during 2019 to 3.42 days during 2020 (P < 0.01). The most pronounced decrease in the length of stay was observed during the second month of the first lockdown. During the pandemic, hospitalized patients at Sheba were older and were less likely to be males. The in-hospital absolute non-COVID mortality decreased from 913 to 858 respectively. CONCLUSIONS: The Covid-19 crisis emphasizes the role of medical wards in the care of complex patients. Medical wards in Israel were at the frontline of Israel's battle against this pandemic, while continuing to treat very complex non-Covid patients. To avoid burnout of the medical staff who treat very intensively complex patients, we believe these wards should be strengthen with specialists having expertise in treating these patients. Due to our insights, the Sheba medical Center is now redesigning the concept of how intensive care beds should be managed in a big tertiary center.


Assuntos
COVID-19 , Pandemias , Controle de Doenças Transmissíveis , Serviço Hospitalar de Emergência , Hospitalização , Hospitais , Humanos , Israel/epidemiologia , Masculino , SARS-CoV-2
7.
Sci Rep ; 11(1): 21002, 2021 10 25.
Artigo em Inglês | MEDLINE | ID: covidwho-1483148

RESUMO

COVID19 infection was associated with possible psychiatric manifestations, including psychosis and mania. In addition, psychiatric disorders might be triggered by severe psychological reactions to the pandemic or the measures taken to contain it. This study aimed to assess the trends of new-onset psychosis/mania during the pandemic timeline. Psychiatric emergency department records during January-July 2019 and 2020 of two regional mental health centers were manually examined. Cases of new-onset psychosis or mania were found in 326 out of 5161 records examined. The ratio of these cases increased by 45.5% in 2020 compared to 2019 (189 out of 2367, 137 out of 2479, respectively, p = 0.001). The peak increase was in April 2020 (9.4% vs. 4.7%, p = 0.015). There was no association between the rise of new-onset psychotic or manic episodes and national incidence of COVID19 cases, as observed during Israel 2nd wave. PCR tests were negative, except a single case. In this study, an increase in new-onset psychosis/mania was identified during the initial phase of the pandemic. Though causality could not be directly inferred, lack of infection symptoms, negative PCR testing and temporal distribution incongruent with COVID19 caseload did not support a direct effect of SARS-CoV-2. Alternative explanations are discussed, such as psychological reaction to stress and preventive measures, as well as case-shifting between different mental health settings.


Assuntos
Transtorno Bipolar/epidemiologia , COVID-19/epidemiologia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Hospitais Psiquiátricos/estatística & dados numéricos , Transtornos Psicóticos/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Transtorno Bipolar/psicologia , Teste de Ácido Nucleico para COVID-19 , Registros Eletrônicos de Saúde , Serviço Hospitalar de Emergência/tendências , Feminino , Hospitais Psiquiátricos/tendências , Humanos , Israel/epidemiologia , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Pandemias , Transtornos Psicóticos/psicologia , Estresse Psicológico , Adulto Jovem
8.
BMC Public Health ; 21(1): 1521, 2021 08 06.
Artigo em Inglês | MEDLINE | ID: covidwho-1477368

RESUMO

BACKGROUND: The COVID-19 outbreak holds public health concerns. The stay-at-home increases sedentary behavior, with unintended adverse outcomes. Since organized recreation and sports facilities were closed, we aimed to study how the crisis of closure affected exercise habits and weight gain among the trainee population in Israel. We examined differences in weight gain among individuals with different PA activities and assessed their ability to adapt to digital media as an alternative training structure. METHODS: A cross-sectional survey consisted of a multiple-choice questionnaire obtained using a web-based survey application. Trainees (1202) who exercised steadily anonymously answered the questionnaire sent by their coaches regarding their activity and weight gain during lockdown times. RESULTS: Results confirmed that 70% of Israelis trained less than their usual routine, 60% used digital media for training, 55% gained weight. Half of the respondents gained more than 2 kg, with an average increase of 1.2 kg. However, those who exhibited a higher physical activity level gained less weight. Using digital media for training was associated with higher physical activity levels. The aged population was less likely to use digital media. CONCLUSIONS: Since increased sedentary behavior could increase the risk for potential worsening of health conditions, health agencies should look for strategies, including digital remote media training to promote physical activity and subsequently, preventing the increased burden of future comorbidities worsening by a sedentary lifestyle. Approval: by the Helsinki ethics committee of Sheba Medical Center (6504-19-SMC).


Assuntos
COVID-19 , Adulto , Idoso , Controle de Doenças Transmissíveis , Estudos Transversais , Exercício Físico , Humanos , Internet , Israel/epidemiologia , SARS-CoV-2 , Ganho de Peso
9.
Microbiol Spectr ; 9(2): e0087021, 2021 10 31.
Artigo em Inglês | MEDLINE | ID: covidwho-1455682

RESUMO

The first case of SARS-CoV-2 was discovered in Israel in late February 2020. Three major outbreaks followed, resulting in over 800,000 cases and over 6,000 deaths by April 2021. Our aim was characterization of a serological snapshot of Israeli patients and healthy adults in the early months of the COVID-19 pandemic. Sera from 55 symptomatic COVID-19 patients and 146 healthy subjects (early-pandemic, reverse transcription-quantitative PCR [qRT-PCR]-negative), collected in Israel between March and April 2020, were screened for SARS-CoV-2-specific IgG, IgM, and IgA antibodies, using a 6-plex antigen microarray presenting the whole inactivated virus and five viral antigens: a stabilized version of the spike ectodomain (S2P), spike subunit 1 (S1), receptor-binding-domain (RBD), N-terminal-domain (NTD), and nucleocapsid (NC). COVID-19 patients, 4 to 40 days post symptom onset, presented specific IgG to all of the viral antigens (6/6) in 54 of the 55 samples (98% sensitivity). Specific IgM and IgA antibodies for all six antigens were detected in only 10% (5/55) and 4% (2/55) of the patients, respectively, suggesting that specific IgG is a superior serological marker for COVID-19. None of the qRT-PCR-negative sera reacted with all six viral antigens (100% specificity), and 48% (70/146) were negative throughout the panel. Our findings confirm a low seroprevalence of anti-SARS-CoV-2 antibodies in the Israeli adult population prior to the COVID-19 outbreak. We further suggest that the presence of low-level cross-reacting antibodies in naive individuals calls for a combined, multiantigen analysis for accurate discrimination between naive and exposed individuals. IMPORTANCE A 6-plex protein array presenting the whole inactivated virus and five nucleocapsid and spike-derived SARS-CoV-2 antigens was used to generate a serological snapshot of SARS-CoV-2 seroprevalence and seroconversion in Israel in the early months of the pandemic. Our findings confirm a very low seroprevalence of anti-SARS-CoV-2 antibodies in the Israeli adult population. We further propose that the presence of low-level nonspecific antibodies in naive individuals calls for a combined, multiantigen analysis for accurate discrimination between naive and exposed individuals enabling accurate determination of seroconversion. The developed assay is currently applied to evaluate immune responses to the Israeli vaccine during human phase I/II trials.


Assuntos
Anticorpos Antivirais/sangue , Teste Sorológico para COVID-19/métodos , COVID-19/epidemiologia , Análise em Microsséries/métodos , SARS-CoV-2/imunologia , Adulto , Idoso , Antígenos Virais/imunologia , Proteínas do Nucleocapsídeo de Coronavírus/imunologia , Feminino , Humanos , Imunoensaio/métodos , Imunoglobulina A/sangue , Imunoglobulina G/sangue , Imunoglobulina M/sangue , Israel/epidemiologia , Masculino , Pessoa de Meia-Idade , Fosfoproteínas/imunologia , Sensibilidade e Especificidade , Estudos Soroepidemiológicos , Glicoproteína da Espícula de Coronavírus/imunologia , Adulto Jovem
10.
Microbiol Spectr ; 9(2): e0050621, 2021 10 31.
Artigo em Inglês | MEDLINE | ID: covidwho-1455679

RESUMO

Emerging SARS-CoV-2 (SC-2) variants with increased infectivity and vaccine resistance are of major concern. Rapid identification of such variants is important for the public health decision making and to provide valuable data for epidemiological and policy decision making. We developed a multiplex reverse transcriptase quantitative PCR (RT-qPCR) assay that can specifically identify and differentiate between the emerging B.1.1.7 and B.1.351 SC-2 variants. In a single assay, we combined four reactions-one that detects SC-2 RNA independently of the strain, one that detects the D3L mutation, which is specific to variant B.1.1.7, one that detects the 242 to 244 deletion, which is specific to variant B.1.351, and the fourth reaction, which identifies the human RNAseP gene, serving as an endogenous control for RNA extraction integrity. We show that the strain-specific reactions target mutations that are strongly associated with the target variants and not with other major known variants. The assay's specificity was tested against a panel of respiratory pathogens (n = 16), showing high specificity toward SC-2 RNA. The assay's sensitivity was assessed using both in vitro transcribed RNA and clinical samples and was determined to be between 20 and 40 viral RNA copies per reaction. The assay performance was corroborated with Sanger and whole-genome sequencing, showing complete agreement with the sequencing results. The new assay is currently implemented in the routine diagnostic work at the Central Virology Laboratory, and may be used in other laboratories to facilitate the diagnosis of these major worldwide-circulating SC-2 variants. IMPORTANCE This study describes the design and utilization of a multiplex reverse transcriptase quantitative PCR (RT-qPCR) to identify SARS-COV-2 (SC2) RNA in general and, specifically, to detect whether it is of lineage B.1.1.7 or B.1.351. Implementation of this method in diagnostic and research laboratories worldwide may help the efforts to contain the COVID-19 pandemic. The method can be easily scaled up and be used in high-throughput laboratories, as well as small ones. In addition to immediate help in diagnostic efforts, this method may also help in epidemiological studies focused on the spread of emerging SC-2 lineages.


Assuntos
COVID-19/diagnóstico , Sequenciamento de Nucleotídeos em Larga Escala/métodos , Ensaios de Triagem em Larga Escala/métodos , SARS-CoV-2/classificação , SARS-CoV-2/genética , COVID-19/epidemiologia , COVID-19/virologia , Genoma Viral/genética , Humanos , Israel/epidemiologia , RNA Viral/genética , Reação em Cadeia da Polimerase Via Transcriptase Reversa , SARS-CoV-2/imunologia , SARS-CoV-2/isolamento & purificação , Sensibilidade e Especificidade , Sequenciamento Completo do Genoma
11.
J Hepatol ; 75(2): 435-438, 2021 08.
Artigo em Inglês | MEDLINE | ID: covidwho-1454287

RESUMO

BACKGROUND & AIMS: Two SARS-CoV-2 mRNA vaccines were approved to prevent COVID-19 infection, with reported vaccine efficacy of 95%. Liver transplant (LT) recipients are at risk of lower vaccine immunogenicity and were not included in the registration trials. We assessed vaccine immunogenicity and safety in this special population. METHODS: LT recipients followed at the Tel-Aviv Sourasky Medical Center and healthy volunteers were tested for SARS-CoV-2 IgG antibodies directed against the Spike-protein (S) and Nucleocapsid-protein (N) 10-20 days after receiving the second Pfizer-BioNTech BNT162b2 SARS-CoV-2 vaccine dose. Information regarding vaccine side effects and clinical data was collected from patients and medical records. RESULTS: Eighty LT recipients were enrolled. Mean age was 60 years and 30% were female. Twenty-five healthy volunteer controls were younger (mean age 52.7 years, p = 0.013) and mostly female (68%, p = 0.002). All participants were negative for IgG N-protein serology, indicating immunity did not result from prior COVID-19 infection. All controls were positive for IgG S-protein serology. Immunogenicity among LT recipients was significantly lower with positive serology in only 47.5% (p <0.001). Antibody titer was also significantly lower in this group (mean 95.41 AU/ml vs. 200.5 AU/ml in controls, p <0.001). Predictors for negative response among LT recipients were older age, lower estimated glomerular filtration rate, and treatment with high dose steroids and mycophenolate mofetil. No serious adverse events were reported in either group. CONCLUSION: LT recipients developed substantially lower immunological response to the Pfizer-BioNTech SARS-CoV-2 mRNA-based vaccine. Factors influencing serological antibody responses include age, renal function and immunosuppressive medications. The findings require re-evaluation of vaccine regimens in this population. LAY SUMMARY: The Pfizer-BioNTech BNT162b2 SARS-CoV-2 vaccine elicited substantially inferior immunity in liver transplant recipients. Less than half of the patients developed sufficient levels of antibodies against the virus, and in those who were positive, average antibody levels were 2x less compared to healthy controls. Factors predicting non-response were older age, renal function and immunosuppressive medications.


Assuntos
Anticorpos Antivirais/sangue , Vacinas contra COVID-19 , COVID-19 , Imunogenicidade da Vacina/imunologia , Imunoglobulina G/sangue , Imunossupressores/uso terapêutico , Transplante de Fígado/métodos , COVID-19/epidemiologia , COVID-19/prevenção & controle , Vacinas contra COVID-19/administração & dosagem , Vacinas contra COVID-19/efeitos adversos , Vacinas contra COVID-19/imunologia , Feminino , Humanos , Imunossupressão/métodos , Israel/epidemiologia , Testes de Função Renal , Masculino , Pessoa de Meia-Idade , Fatores de Risco , SARS-CoV-2/imunologia , Testes Sorológicos/métodos , Testes Sorológicos/estatística & dados numéricos , Vacinação/efeitos adversos , Vacinação/métodos
12.
BMC Public Health ; 21(1): 1543, 2021 08 12.
Artigo em Inglês | MEDLINE | ID: covidwho-1351119

RESUMO

BACKGROUND: Influenza is a substantial cause of morbidity and mortality for Israel and the Palestinian territory. Given the extensive interaction between the two populations, vaccination in one population may indirectly benefit the other via reduced transmission. Due to the mobility and extensive contacts, Palestinians employed in Israel could be a prime target for vaccination. METHODS: To evaluate the epidemiological and the economic benefits conferred by vaccinating Palestinians employed in Israel, we developed a model of influenza transmission within and between Israel and the West Bank. We parameterized the contact patterns underlying transmission by conducting a survey among Palestinians employed in Israel, and integrating survey results with traffic patterns and socio-demographic data. RESULTS: Vaccinating 50% of Palestinian workers is predicted to reduce the annual influenza burden by 28,745 cases (95% CI: 15,031-50,717) and 37.7 deaths (95% CI: 19·9-65·5) for the Israeli population, and by 32,9900 cases (95% CI: 14,379-51,531) and 20.2 deaths (CI 95%: 9·8-31·5) for the Palestinian population. Further, we found that as the indirect protection was so substantial, funding such a vaccination campaign would be cost-saving from the Israeli Ministry of Health perspective. CONCLUSIONS: Offering influenza vaccination to Palestinians employed in Israel could efficiently reduce morbidity and mortality within both Israel and the Palestinian territory.


Assuntos
Vacinas contra Influenza , Influenza Humana , Análise Custo-Benefício , Humanos , Programas de Imunização , Influenza Humana/epidemiologia , Influenza Humana/prevenção & controle , Israel/epidemiologia , Inquéritos e Questionários , Vacinação
13.
Emerg Infect Dis ; 27(11): 2919-2922, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: covidwho-1441081

RESUMO

In Israel, the BNT162b2 vaccine against severe acute respiratory syndrome coronavirus 2 was approved for use in adolescents in June 2021, shortly before an outbreak of B.1.617.2 (Delta) variant-dominant infection. We evaluated short-term vaccine effectiveness and found the vaccine to be highly effective among this population in this setting.


Assuntos
COVID-19 , Vacinas , Adolescente , Vacinas contra COVID-19 , Surtos de Doenças , Humanos , Israel/epidemiologia , SARS-CoV-2
14.
Melanoma Res ; 31(4): 389-392, 2021 08 01.
Artigo em Inglês | MEDLINE | ID: covidwho-1434530

RESUMO

The Novel Coronavirus disease (COVID-19) first emerged in Wuhan province, China, in late November 2019 and changed public healthcare perception. It has caused a significant decline in attendance to outpatient clinics. However, other diseases have not stopped, including malignant melanoma. Survey of the number of visits to plastic surgery outpatient clinic during the first lockdown in Israel concerning malignant melanoma was compared to the same months in the previous years. We assessed the number of visits to the oncology department during 2020 compared to the number of visits and treatment protocols for malignant melanoma. During the first lockdown, the attendance at the plastic surgery outpatient clinic and ambulatory surgery decreased significantly (P = 0.002), both in excisions of suspected malignant melanoma and malignant melanoma follow-ups (P = 0.019 and P = 0.035, respectively). The last third of 2020 (from September to December) had shown a significant rise in new protocols commenced (P < 0.001). This rise in the final third of the year was not noted in 2018 or 2019. These data clearly show the rise in advanced and metastatic malignant melanoma cases due to refraining from medical follow-ups and treatments during the COVID-19 pandemic. Diseases other than COVID-19 have not vanished, and continue to treat those diseases. Ignoring malignant melanoma treatment because of COVID-19 and vice-versa will not benefit our patients.


Assuntos
Agendamento de Consultas , COVID-19/prevenção & controle , Melanoma/epidemiologia , Aceitação pelo Paciente de Cuidados de Saúde , Neoplasias Cutâneas/epidemiologia , COVID-19/epidemiologia , COVID-19/transmissão , Humanos , Israel/epidemiologia , Melanoma/diagnóstico , Melanoma/terapia , Neoplasias Cutâneas/diagnóstico , Neoplasias Cutâneas/terapia , Fatores de Tempo , Carga de Trabalho
16.
JAMA ; 326(8): 728-735, 2021 08 24.
Artigo em Inglês | MEDLINE | ID: covidwho-1427006

RESUMO

Importance: Data on BNT162b2 messenger RNA (mRNA) vaccine (Pfizer-BioNTech) effectiveness and safety in pregnancy are currently lacking because pregnant women were excluded from the phase 3 trial. Objective: To assess the association between receipt of BNT162b2 mRNA vaccine and risk of SARS-CoV-2 infection among pregnant women. Design, Setting, and Participants: This was a retrospective cohort study within the pregnancy registry of a large state-mandated health care organization in Israel. Pregnant women vaccinated with a first dose from December 19, 2020, through February 28, 2021, were 1:1 matched to unvaccinated women by age, gestational age, residential area, population subgroup, parity, and influenza immunization status. Follow-up ended on April 11, 2021. Exposures: Exposure was defined by receipt of the BNT162b2 mRNA vaccine. To maintain comparability, nonexposed women who were subsequently vaccinated were censored 10 days after their exposure, along with their matched pair. Main Outcomes and Measures: The primary outcome was polymerase chain reaction-validated SARS-CoV-2 infection at 28 days or more after the first vaccine dose. Results: The cohort included 7530 vaccinated and 7530 matched unvaccinated women, 46% and 33% in the second and third trimester, respectively, with a mean age of 31.1 years (SD, 4.9 years). The median follow-up for the primary outcome was 37 days (interquartile range, 21-54 days; range, 0-70). There were 118 SARS-CoV-2 infections in the vaccinated group and 202 in the unvaccinated group. Among infected women, 88 of 105 (83.8%) were symptomatic in the vaccinated group vs 149 of 179 (83.2%) in the unvaccinated group (P ≥ .99). During 28 to 70 days of follow-up, there were 10 infections in the vaccinated group and 46 in the unvaccinated group. The hazards of infection were 0.33% vs 1.64% in the vaccinated and unvaccinated groups, respectively, representing an absolute difference of 1.31% (95% CI, 0.89%-1.74%), with an adjusted hazard ratio of 0.22 (95% CI, 0.11-0.43). Vaccine-related adverse events were reported by 68 patients; none was severe. The most commonly reported symptoms were headache (n = 10, 0.1%), general weakness (n = 8, 0.1%), nonspecified pain (n = 6, <0.1%), and stomachache (n = 5, <0.1%). Conclusions and Relevance: In this retrospective cohort study of pregnant women, BNT162b2 mRNA vaccination compared with no vaccination was associated with a significantly lower risk of SARS-CoV-2 infection. Interpretation of study findings is limited by the observational design.


Assuntos
Vacinas contra COVID-19/administração & dosagem , COVID-19/epidemiologia , Complicações Infecciosas na Gravidez/epidemiologia , Gestantes , Adulto , COVID-19/imunologia , COVID-19/prevenção & controle , Vacinas contra COVID-19/efeitos adversos , Vacinas contra COVID-19/imunologia , Estudos de Casos e Controles , Intervalos de Confiança , Feminino , Idade Gestacional , Humanos , Incidência , Israel/epidemiologia , Estimativa de Kaplan-Meier , Gravidez , Complicações Infecciosas na Gravidez/imunologia , Complicações Infecciosas na Gravidez/prevenção & controle , Análise de Regressão , Estudos Retrospectivos , Risco , Fatores de Tempo , Vacinação/estatística & dados numéricos
18.
N Engl J Med ; 385(15): 1393-1400, 2021 10 07.
Artigo em Inglês | MEDLINE | ID: covidwho-1410382

RESUMO

BACKGROUND: On July 30, 2021, the administration of a third (booster) dose of the BNT162b2 messenger RNA vaccine (Pfizer-BioNTech) was approved in Israel for persons who were 60 years of age or older and who had received a second dose of vaccine at least 5 months earlier. Data are needed regarding the effect of the booster dose on the rate of confirmed coronavirus 2019 disease (Covid-19) and the rate of severe illness. METHODS: We extracted data for the period from July 30 through August 31, 2021, from the Israeli Ministry of Health database regarding 1,137,804 persons who were 60 years of age or older and had been fully vaccinated (i.e., had received two doses of BNT162b2) at least 5 months earlier. In the primary analysis, we compared the rate of confirmed Covid-19 and the rate of severe illness between those who had received a booster injection at least 12 days earlier (booster group) and those who had not received a booster injection (nonbooster group). In a secondary analysis, we evaluated the rate of infection 4 to 6 days after the booster dose as compared with the rate at least 12 days after the booster. In all the analyses, we used Poisson regression after adjusting for possible confounding factors. RESULTS: At least 12 days after the booster dose, the rate of confirmed infection was lower in the booster group than in the nonbooster group by a factor of 11.3 (95% confidence interval [CI], 10.4 to 12.3); the rate of severe illness was lower by a factor of 19.5 (95% CI, 12.9 to 29.5). In a secondary analysis, the rate of confirmed infection at least 12 days after vaccination was lower than the rate after 4 to 6 days by a factor of 5.4 (95% CI, 4.8 to 6.1). CONCLUSIONS: In this study involving participants who were 60 years of age or older and had received two doses of the BNT162b2 vaccine at least 5 months earlier, we found that the rates of confirmed Covid-19 and severe illness were substantially lower among those who received a booster (third) dose of the BNT162b2 vaccine.


Assuntos
Vacinas contra COVID-19 , COVID-19/prevenção & controle , Imunização Secundária , Idoso , Idoso de 80 Anos ou mais , COVID-19/epidemiologia , Bases de Dados Factuais , Feminino , Humanos , Israel/epidemiologia , Masculino , Pessoa de Meia-Idade , Gravidade do Paciente , Distribuição de Poisson , SARS-CoV-2
19.
Int J Environ Res Public Health ; 18(18)2021 09 10.
Artigo em Inglês | MEDLINE | ID: covidwho-1409557

RESUMO

Following the worldwide outbreak of COVID-19, policymakers have been occupied with the questions of whether and how to specially address unique cultural groups coping with the pandemic. This study aimed to evaluate the potential for a culturally tailored approach to the transmission of health messages in a time of crisis among two minority populations within Israeli society: the Ultra-Orthodox population and the Arab population. To that end, 380 individuals from Israeli Ultra-Orthodox society and 360 individuals from Israeli Arab society completed a self-reported questionnaire in early April 2020, in the midst of the COVID-19 pandemic. The findings of this study reveal differences between these groups in terms of the effectiveness of different channels for conveying messages and the channels that were preferred, as well as significant relationships between community sense of coherence and the study variables. We found that advocacy and motivation based on values, on the one hand, and recognition of the effectiveness of a culturally tailored approach, on the other, may be the best approach for persuading members of minority populations, who belong to collectivist societies, to comply with epidemic-control instructions.


Assuntos
COVID-19 , Pandemias , Árabes , Humanos , Israel/epidemiologia , Judeus , SARS-CoV-2
20.
Orphanet J Rare Dis ; 16(1): 379, 2021 09 08.
Artigo em Inglês | MEDLINE | ID: covidwho-1403248

RESUMO

BACKGROUND: Severe acute respiratory syndrome coronavirus 2 (SARS CoV-2) is the causative agent of the current COVID-19 pandemic. Lysosomal storage disorders (LSD) comprise of 70 inherited inborn errors of metabolism. Affected individuals suffer from multi-systemic involvement with variable severity and rate of disease progression between different diseases. Some of the LSDs have established treatments, whether parenteral or oral therapies. The full impact of the COVID-19 pandemic together with the lockdown on the wellbeing and medical management of patients with rare diseases, such as LSDs, is widely unknown. Herein, we describe the effects of the COVID-19 pandemic and its associated mandatory home lockdown on patients with LSDs in Israel. RESULTS: We present a prospective multi-center questionnaire study including 48 LSD patients from four medical centers in Israel. The study objective was to assess the impact of the COVID-19 pandemic restrictions on individuals with LSDs in Israel, as reported by their caregivers. Secondary objectives were to assess the morbidity from SARS CoV-2 in LSD patients and the impact of changes in mood and behavior on compliance to treatment and to assess the relationship between changes in mood to changes in cognition and behavior. Thirty one of 38 patients (82%) who received any kind of regular treatment did not miss treatments. Among patients receiving enzyme replacement therapy (ERT) in the in-hospital setting, 5 patients (20%) experienced treatment disruptions. Four patients had tested positive for SARS-Cov-2 virus infection by PCR. Seven out of the 48 patients (14%) described mood changes with cognitive and motor deterioration during the home quarantine. CONCLUSIONS: We observed high rates of treatment adherence and low morbidity through the COVID-19 pandemic in patients with LSDs in Israel. LSDs patients can be a model for patients with complex chronic diseases requiring routine treatments and surveillance during a pandemic or other disruption of daily routine.


Assuntos
COVID-19 , Pandemias , Controle de Doenças Transmissíveis , Humanos , Israel/epidemiologia , Lisossomos , Estudos Prospectivos , SARS-CoV-2
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